<include file="../header" />
<div class="wrapper">
    <div class="header text-center font-16">
        申请
        <div class="iconfont icon-zuo go_back"></div>
    </div>
    <div class="history-list">
        <div class="repair-list gray2">
            <select name=""  >
                <option value="1">维修工</option>
            </select>
            <div class="iconfont icon-zuo-copy "></div>
        </div>
        <div class="repair-list ">
            <input type="text" placeholder="请输入姓名">
        </div>
    </div>
    <a href="#" class="btn text-center order_receiving">提交</a>
</div>
<include file="../footer" />
<script src="/assets/repaireast/js/layer.js"></script>
<script src="/assets/repaireast/js/public.js"></script>
<script>

    $('.btn').click(function () {
        fm.alert('请输入姓名');
    })
</script>